MEDICARE: ANDREA KARKLINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	209017561	IL
2	163W00000X	Registered Nurse	041391562	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	041391562	OTHER	IL	REGISTERED NURSE
2	209017561	OTHER	IL	ADVANCED PRACTICE NURSE

General Provider Information

NPI Number	:	1063994887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA KARKLINS

Provider Business Mailing Address
First Line	:	3726 W MCLEAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-3418
Country	:	US
Telephone Number	:	773-387-6516
Fax Number	:

Provider Business Practice Location Address
First Line	:	3726 W MCLEAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-3418
Country	:	US
Telephone Number	:	773-387-6516
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2018
Last Update Date	:	08/29/2018

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Directions to “ ANDREA KARKLINS ” Practice Location

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